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Impact of Month of Birth on the Risk of Development of Autoimmune Addison's Disease

Lookup NU author(s): Dr Agnieszka Pazderska, Dr Anna MitchellORCiD, Dr Catherine Napier, Dr Earn Gan, Dr Mauro Santibanez Koref, Professor Simon PearceORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Context: The pathogenesis of autoimmune Addison's disease (AAD) is thought to be due to interplay of genetic, immune, and environmental factors. A month-of-birth effect, with increased risk for those born in autumn/winter months, has been described in autoimmune conditions such as type 1 diabetes and autoimmune thyroid disease.Objective: Month-of-birth effect was investigated in 2 independent cohorts of AAD subjects.Design, Setting, and Patients: The monthly distribution of birth in AAD patients was compared with that of the general population using the cosinor test. A total of 415 AAD subjects from the United Kingdom cohort were compared with 8 180 180 United Kingdom births, and 231 AAD subjects from the Polish cohort were compared with 2 421 384 Polish births.Main Outcome Measures: Association between month of birth and the susceptibility to AAD.Results: In the entire cohort of AAD subjects, month-of-birth distribution analysis showed significant periodicity with peak of births in December and trough in May (P = .028). Analysis of the odds ratio distribution based on month of birth in 2 cohorts of patients with AAD versus the general population revealed a December peak and May trough, and January peak and July trough, in the United Kingdom and Polish cohorts, respectively.Conclusion: For the first time, we demonstrate that month of birth exerts an effect on the risk of developing AAD, with excess risk in individuals born in winter months and a protective effect when born in the summer. Exposure to seasonal viral infections in the perinatal period, coupled with vitamin D deficiency, could lead to dysregulation of innate immunity affecting the risk of developing AAD.

Publication metadata

Author(s): Pazderska A, Fichna M, Mitchell AL, Napier CM, Gan E, Ruchala M, Santibanez-Koref M, Pearce SH

Publication type: Article

Publication status: Published

Journal: Journal of Clinical Endocrinology & Metabolism

Year: 2016

Volume: 101

Issue: 11

Pages: 4214-4218

Print publication date: 01/11/2016

Online publication date: 30/08/2016

Acceptance date: 26/08/2016

Date deposited: 02/03/2017

ISSN (print): 0021-972X

ISSN (electronic): 1945-7197

Publisher: Endocrine Society


DOI: 10.1210/jc.2016-2392


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Funder referenceFunder name
National Institute for Health Research Academic Clinical Lecturer Program
Exchange in Endocrinology Expertise (3E) Program of the European Union of Medical Specialists, Section and Board of Endocrinology
MR/J002526Medical Research Council